return to: Nursing Protocols

Purpose: To address essential components of the head and neck patient's post-operative care.

I. Patient's pain must be addressed:

A. Importance of how and when to report pain intensity using appropriate scale (Numeric, Verbal Descriptor, or Faces).

B. Use of nonverbal scales to assess pain when needed (Non-verbal Pain indicators: Adult, FLACC, or ICHIPS).

C. Pain control options and importance of requesting pain interventions before pain becomes severe. 

            1. Analgesic dose(s), route(s), frequency(s), and potential side effects. Proper use of non-drug strategies.

D. For pediatric patients, patient and/or family are given the pamphlet(s): Helping Your Child with Pain Control or Infant Pain Control. Content is reviewed and questions are answered.

II. Respiratory care for the post-operative head and neck patient is particularly important:

A. Spirometry use as ordered.

B. Turn, cough, deep breathe.

C. Humidified oxygen/air to keep oral tissue and airway moist.

D. Tracheostomy tube care including normal saline instillation, suctioning and inner cannula care.

III. Communication:

A. Discuss effective means of communication including method for patient to alert staff/use of intercom if patient unable to talk. There are several tools available on the inpatient unit:

              1. White board with marker, pen/paper

              2. When appropriate to procedure (e.g. laryngectomy) speech therapy will be initiated, involving teaching patient how to use electrlarynx tool.

IV. Safety precautions should be expressed as a shared repsonisbility between the patient and nursing staff staff:

A. Explain the importance of suction, obturator and spare trach at bedside. Incorporate proper use of these items in teaching.

B. Discuss importance of never using paper tissues near trach.

V. Describe and perform skin care of operative area for patient and other relevant caregivers:

A. Patient/parent/family will be able to describe signs of impending skin breakdown and ways to prevent it.

      1. Teach patient to look for increased redness or warmth around stoma site.

      2. Teach patient the use of vaseline and bibs when appropriate to preserve skin integrity as needed.

B. Patient/parent/family will be able to demonstrate proper procedure for skin care at the tracheostomy site.

       1. As instructed, use normal saline, betadine application and avoid contamination of the airway if bacitracin or vaseline is used to maintain skin integrity.

VI. Discharge planning should begin at admission and the following issues, at minimum, must be addressed throughout patient stay:

A. Clarify what home equipment and medications will be needed.

        1. Suction, oxygen, tube/peg feedings.

B. Discuss possibility of needing a VNA service or skilled nursing facility.

         1. What resources does the patient already have available? Does the patient live alone? Is there somebody in the patient's life who can help with cares? Does the patient have any support?

C. Discuss when to seek emergency care.

          1. CPR/tracheostomy care training to family.

          2. Suctioning techniques.

D. Review symptoms to report immediately.

1. SOB, increased cough, difficulty breathing, increased amount of secretions, change in color/consistency of secretions, signs or symptoms of infection such as elevated temperature, increased redness or warmth at stoma, foul odor from secretions/stoma, excess swelling or bleeding at stoma, nausea/vomiting, uncontrolled pain and constipation.